There are many different names you might find for the autoimmune eye condition that is often
seen with thyroid disease, including:

Thyroid Eye Disease, sometimes abbreviated as TED

Graves' Opthamolopathy

Thyroid-associated orbitopathy (TAO)

Grave's orbitopathy

Thyroid Eye Disease is an autoimmune eye condition that, while separate from thyroid disease, is
often seen in conjunction with Graves' Disease. The condition, however, is seen in people with
no other evidence of thyroid dysfunction, and occasionally in patients who have Hashimoto's
Disease. Most thyroid patients, however, will not develop thyroid eye disease, and if so, only
mildly so.

Signs and Symptoms of Thyroid Eye Disease

Signs and symptoms include:

Pain in the eyes, pain when looking up, down or sideways

Dryness, itching, dry eyes, difficulty wearing contact lenses

Inflammation and swelling of the eye, and its surrounding tissues

Swelling in the orbital tissues which causes the eye to be pushed forward -- referred to as
exophthalmos -- which can make Thyroid Eye Disease sufferers appear to have a wide-eyed or
bulging stare.

Bloodshot appearance to eyes

Double vision (doctors call it diplopia)

Impaired vision

Thyroid Eye Disease is known to go through varying degrees of severity, and can go into periods
of remission as well. When it has been inactive for a period of around a half a year, it's less
likely to recur.

According to a Jan. 27, 1993 article in the Journal of the American Medical Association,
smokers are twice as likely as nonsmokers to develop Graves' disease. According to that article,
smoking also apparently worsens eye problems in people with Graves' disease.

Researchers have also recently learned that smoking reduces the effectiveness of treatments for
thyroid eye disease. The researchers reviewed the outcomes of 300 Graves' disease patients with
mild eye symptoms treated with radioiodine alone or with steriods, and 150 with serious eye
complications who received steroids and radiation therapy for their thyroid eye disease.

Among Graves' disease patients who had milder eye symptoms, smokers were more likely to
progress to more serious thyroid eye disease than nonsmokers. Radioidone and steroid treatment
for thyroid eye disease was also four times more effective in dealing with the eye symptoms for
nonsmokers than smokers. This same relationship also applied to patients with more serious
thyroid eye disease. ("Smoking affects Graves' disease treatment," Annals of Internal
Medicine, 1998;129:632-635.)

Treatments

In milder cases of Thyroid Eye Disease, often all that is needed is lubricating eye drops or
ointments for moisture, wraparound sunglasses to avoid glare, bedroom humidifiers to reduce dry
eye problems.
When double vision occurs, some patients respond to the addition or prism lenses in their
eyeglasses.
For pain, swelling and redness, short courses of the steroid prednisone are sometimes prescribed.
Symptoms often return after the course of prednisone therapy, however.

Some doctors recommend orbital radiation, which can be successful in some patients.

In rare cases, when medical treatment has not resolved the retracted and puffy eyelids, or double
vision, doctors will recommend corrective surgery. For some good before and after pictures of
Thyroid Eye Disease surgery results, see the Eyelid-Doc.com website.

Eyelid surgery is primarily cosmetic in nature, and is designed to bring the eyelids into a more
normal position, to improve appearance.

Surgery for double vision works with the muscles that control eye movement.

In a very small percentage of patients, the swelling in the orbital area impairs vision by pressing
on the optic nerve. In these cases, a surgery called orbital decompression is needed in order to
prevent severe complications.

The Issue of Radioactive Iodine Treatment (RAI) for Graves' Disease

Radioactive Iodine (RAI) treatment is the preferred treatment in the U.S. for Graves' Disease and
its resulting hyperthyroidism. According to the New England Journal of
Medicine, however, radioiodine therapy for Graves' hyperthyroidism is more likely to
apparently cause or worsen Thyroid Eye Disease than is antithyroid drug therapy. This worsening
can be temporary however, and may in some cases be prevented by use of the steroid prednisone.